Symptoms dizzy head etc: Hi I have been on Levo... - Thyroid UK

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Symptoms dizzy head etc

Sara197 profile image

Hi I have been on Levo for over a year. Ive been dr bout brain fog. Head spinning and pruney fingers and feet if contact with water for short period of time. Also all joints cracking and hurt. They tell me Im on right dose. Advised to take vit d as low but 2 months in sypmtoms still there virtually continuously. Please can any one give advise. Thank you in advance

65 Replies

Sorry you aren’t feeling well Sara197. It sounds you like are not on the correct dose as these symptoms often appear in patients who are hypo and they certainly appeared for me when I was under medicated. Why were you put on levo in the first place? Have you had a recent blood test to check thyroid levels and vitamin levels? If so, do you have the results? If not ask the surgery receptionist to tell you what your results are including the reference ranges and post them here, this will give the administrators more to go on when giving advice. If you doctor isn’t keen to do a full thyroid blood test, there are private ones you can do for around £29. I’m not an expert (I’ve just been through it) but there are lots of experts on here who will be able to offer great advice if you are able to provide more information.

Sara197 profile image
Sara197 in reply to nataliem19

Hi my thyroid March last year was at 134 i got hypothroid. I had bloods done about 2 and a half months ago due to me feeling exactly how I do now. They said my thrroid bloods come back normal but I had vit d deficiancy advised to take 2000mcg of vit d but I feel like im loseing my marbles at times. And the head spinn makes me feel sick. Even my mouth feels like lips are swelling at edge that rests in my mouth. I wear gloves at work as Im a carer and when they sweat they prune up and that bad at times its painful. I will ask my doctor if he can give me a read out of results can you tell me which results to ask for please. I did say to doctor that i feel im undermedicated as I was so unwell before being diagnosed and it feels like some of the symptoms I had then but the dr said that result was fine.

SlowDragon profile image
SlowDragonAdministrator

Welcome to the forum

How much levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

When were thyroid levels last tested

Please add results and ranges

Exactly What vitamin supplements are you currently taking

How much vitamin D

How low was vitamin D before starting on supplements

When were vitamin D, folate, ferritin and B12 last tested

Sara197 profile image
Sara197 in reply to SlowDragon

Hi Slow DragonIm unsure of how bad vit d was just remember him saying im 10 away from having to take 5000mcg. Im on folic acid as that waslow in november last year. Im on 75mcg of levo. They checked my bloods about 2 months ago

Sara197 profile image
Sara197 in reply to Sara197

Sorry also can different brands of levo make you unwell. I dont always get same brand

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Yes …..Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, or Aristo are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

75mcg levothyroxine is only one step up from starter dose

Which brand of levothyroxine are you currently taking, is it Teva (Teva is only brand that makes 75mcg tablets)

Teva badly upsets many people

Approx how much do you weigh in kilo

Guidelines On dose levothyroxine by weight is approx 1.6mcg per kilo of your weight. So unless very petite, most people will need at least 100mcg levothyroxine per day

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Being under medicated for thyroid results in low stomach acid. This frequently results in poor nutrient absorption and low vitamin levels as direct result

Essential to regularly retest vitamin D twice year when supplementing

Testing folate, ferritin and B12 annually minimum

Do you know if you have had thyroid antibodies tested to confirm autoimmune thyroid disease also called Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease

SlowDragon profile image
SlowDragonAdministrator

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more some less

healthunlocked.com/thyroidu...

The first step to getting well is to get a print-out of your blood test results. You need to know exactly what was tested and exactly what the results were. You cannot take your doctor's word for anything because a) I doubt he know very much about thyroid and b) doctors are notoriously bad at understanding blood test results. These are things they just don't learn in med school. So, if you post your results and ranges on here, experienced patients will be able to interpret them for you. Without them, there's not much anyone can say. :)

Hi yes i take 50mg of teva and 25mg of wockhardit. I am approx 78kg. I have for last 2 months had 75mg of teva . I did have a thyroud antibodies test and that came back ok as receptionist put it.my last blood test I followed the advice off here all as you put above.

Sara197 profile image
Sara197 in reply to Sara197

I will contact doctors on Monday and ask for full read out. Do they have to give it to me or could I be in with a struggle

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively if no online access to test results ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

You are legally entitled to copies of your blood test results and ranges

“OK” on antibodies test ….that’s not a result but an opinion

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Is this how you did your tests

Based on weight …..Likely to need dose increase in levothyroxine up to 100mcg

Teva maybe an issue too.

Teva upsets many people

If not had vitamin D, folate, ferritin and B12 tested, request they are now

Sara197 profile image
Sara197 in reply to SlowDragon

Thank you all for advice I will ring first thing in the morning for test results and get back to you with all results. In the mean time I will buck to see a doctor again and see if I can have antibodies test done again as last test was at last doctors over a year ago.

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

If antibodies test was positive, they are unlikely to repeat it

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Extremely important to regularly retest vitamin D, folate, ferritin and B12, especially if cause is autoimmune thyroid disease

Have you had coeliac blood test done yet

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

78kg x 1.6 = 124mcg as the likely daily dose levothyroxine you will eventually need

But we frequently need to increase dose slowly upwards in 25mcg steps

So getting on 100mcg next step

Print out all guidelines on dose by weight and links I gave you showing TSH should be under 2

Be ready to argue/push for dose increase in levothyroxine to 100mcg daily

Retest in 6-8 weeks

Meanwhile working on improving low vitamin D and B12 levels

Low B12 often causes sensation on walking on small boat/feeling drunk

Get hold of thyroid antibodies test results

Request coeliac blood test done

Ok I will see what doctor suggests as I cant go on feeling this unwell. I will post results as soon as I get them. Thank you all

Sara197 profile image
Sara197 in reply to Sara197

Just saw last bit what is a coeliac blood test for. Im unsure as Ive not heard doctors mention that

helvella profile image
helvellaAdministrator in reply to Sara197

Have a look here:

coeliac.org.uk/information-...

Sara197 profile image
Sara197 in reply to helvella

Ok I dont belive I have been tested for that will mention to the doctor. Thank you

Sara197 profile image
Sara197 in reply to helvella

Sorry I deleted those messages as I think I made a mistake. I think I read email wrong and clicked on donate of which Im fine with. Can I apologise for my mistake.

helvella profile image
helvellaAdministrator in reply to Sara197

No problem!

And I am sure Thyroid UK would say "Thank you". :-)

Sara197 profile image
Sara197 in reply to helvella

Thank you for your understanding.

As has been said you are legally allowed copies of results, I keep all my blood results so I can compare each time they are done, my surgery is very good they will even print them out whilst I wait at reception, always have printed copies or access online , then you have details of exactly what was done and all the results including ranges. Best of luck

Sara197 profile image
Sara197 in reply to elwins

Thank you

I got my blood test read out

Blood test results
Sara197 profile image
Sara197 in reply to Sara197

2nd page

Bloods
SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Was this test done after minimum 6-8 weeks on 75mcg levothyroxine

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

TSH is 2.64

This shows you need 25mcg dose increase in levothyroxine

On levothyroxine TSH should ALWAYS Be under 2

Sara197 profile image
Sara197 in reply to SlowDragon

Slowdragon. Would like to say a huge thankyou for all the info you gave me. Just got off the phone to my doctor. He has uped my dose to 100 and is seeing me in 8 weeks. The doctor himsrlf instead of the nurse I kept getting. Thank you again im nervous at challanging doctors but all the info I sent spoke for me.

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Well done

Never easy to challenge GP

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Suggest you try a different brand other than teva

Available in 100mcg tablets are

Mercury Pharma make 25mcg, 50mcg and 100mcg

Accord, makes 50mcg and 100mcg tablets, also boxed as Almus via Boots or Northstar via Lloyds. But doesn’t make 25mcg tablets

Recommend getting FULL thyroid and vitamins tested via Medichecks, Blue Horizon or Thriva after 6-8 weeks minimum on constant unchanging dose and brand of levothyroxine

Make sure you test early Monday or Tuesday morning and then post back via tracked postal service

Only test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Important to work on improving low vitamin levels as well as this makes it easier to tolerate higher dose levothyroxine and reduces symptoms

Sara197 profile image
Sara197 in reply to SlowDragon

Hi I have ordered all Vitamins you advised and also probiotics as my stomach has been messed up with it all. Yes I will get one of those at home tests. Hopefully find my self again one day.

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Only make one change at a time

So initially increasing levothyroxine

After 2-3 weeks start vitamin D (if not started already)

Wait 2 weeks

Then look at adding the rest one by one, waiting 2 weeks each time

If you start everything at once you can’t see what’s helping or not

Sara197 profile image
Sara197 in reply to SlowDragon

Ive been on vit d for 2 months. Since blood test. So will try b complex next do you think?

Sara197 profile image
Sara197 in reply to Sara197

Started my 100 levo this morning so il give it 2 weeks before starting b complex

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Yes, sounds like a good plan

Remember to stop taking vitamin B complex a week before any blood tests as contains biotin, which can falsely affect test results

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Which brand of levothyroxine is 100mcg ?

Sara197 profile image
Sara197 in reply to SlowDragon

Hi I havent picked them up yet just took another 25mg of what I had

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Try to get

Mercury Pharma (makes 100mcg, 50mcg and 25mcg tablets)

or

Accord brand

Makes 50mcg and 100mcg tablets

Sara197 profile image
Sara197 in reply to SlowDragon

Hi they gave me northstar 100mcg. Ive read that the 25mg are teva. Is this the case yet with the 100mcg

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Northstar 50mcg and 100mcg are Accord brand

Also available in Boots as Almus

Accord don’t make 25mcg tablets

Sara197 profile image
Sara197 in reply to SlowDragon

Ahhh ok. So hopefully be ok off these then. Thankyou

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Contact GP for 25mcg dose increase in levothyroxine up to 100mcg

Suggest you try different brand from Teva unless you suspect you are lactose intolerant

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



 please email Dionne at

tukadmin@thyroiduk.org

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Just testing TSH is completely inadequate

If GP can’t/won’t test TSH, Ft4 and Ft3 use Monitor My Health (private NHS testing service) to get tested

£26.10 if order via Thyroid U.K. website offer code

Sara197 profile image
Sara197 in reply to SlowDragon

Sorry I have emailed above for a copy. Thank you so much for your help

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

No antibodies test results

Can you get these results?

Sara197 profile image
Sara197 in reply to SlowDragon

They were taken when i lived in wales now live in England

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

You should still have access to all previous test results

They will be on your medical record

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Sara197 profile image
Sara197 in reply to SlowDragon

The antibody results the doctors is a 3 hour drive to collect

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

The results are all online and held at your new GP surgery

You don’t need to contact old GP

SlowDragon profile image
SlowDragonAdministrator

Vitamin D and B12 are too low BECAUSE You are under medicated for thyroid

Low vitamin D

GP should prescribe 1600iu everyday for 6 months

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving vitamin D to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hypothyroidism we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

Notice how much vitamin D many of these medics are taking

vitamind4all.org/letter.pdf

SlowDragon profile image
SlowDragonAdministrator

Only add one supplement at a time and then wait at least 10-14 days to assess any reactions ……before adding another

B vitamins

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

B vitamins best taken after breakfast

Thorne Basic B is an option that contain folate, but is large capsule. You can tip powder out if can’t swallow capsule

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

Sara197 profile image
Sara197 in reply to SlowDragon

Wow alot to take in lol. Thankyou for all that. How can I get them to give me higher dose of levo. Would that solve all the above

Sara197 profile image
Sara197 in reply to Sara197

Ok yes test was at 9am last dose of levo was 12hours before. No food and only water from 12 hours previous. Been on levo for nearly year and half

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

After next dose increase to 100mcg

Getting FULL Thyroid And vitamin testing done via Medichecks or Blue horizon

Only do test early Monday or Tuesday morning and then post back via tracked postal service

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

This gives 24 hours between last dose levothyroxine and test for accurate Ft4 results

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Make an appointment with GP

Print out guidelines on dose by weight

And links that show TSH should always be under 2

Be ready to push for dose increase in levothyroxine, as a “trial” if necessary

Many GP’s are clueless on how to manage patients on levothyroxine

Meanwhile working on improving low vitamin levels will help improve symptoms

Find out if thyroid antibodies were high

If TPO antibodies weren’t high, NHS refuses to test TG antibodies

So will need to include in your private testing next time

Sara197 profile image
Sara197 in reply to SlowDragon

Doctors here only doing phone appointments

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

So can be harder to get point across

You can send email/letter before phone appointment

Others have had success doing this

They then have to justify why they are NOT following guidelines on dose by weight, keeping TSH below 2 etc

Sara197 profile image
Sara197 in reply to SlowDragon

Ok Thankyou so much for your advice. I will ring for an appount ment now might get one in about 5 days

Sara197 profile image
Sara197 in reply to Sara197

I have got an appointment for satirday morning. Would it be best I download all the attatchments you have sent me and email them to the doctors the day before

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

I would write an email

Include tick list of hypothyroid symptoms

Include links to relevant articles

And copy and paste relevant sections into your letter

Keep letter short

Hi please can you tell me what I google to gain the information for guidelines please

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

In my previous replies

Here guidelines on TSH

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

guidelines on dose levothyroxine by weight

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

SlowDragon profile image
SlowDragonAdministrator in reply to Sara197

Tick list of symptoms

mk0thyroiduky0qtp9yo.kinsta...

Hi sorry me message sounds rood. I did not mean it as you have scammed me lol. I must learn to message clearer.

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